Chain of custody record, Westchester County Labs

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s WESTCHESTER COUNTY DEPARTMENT OF LABS & RESEARCH CHAIN OF CUSTODY RECORD PAGE I OF i o <o

§ s o o o SDG# NAME CONTACT LABORATORY WESTCHESTER COUNTY ADDRESS CONTACT VALHALLA, NEW YORK _____________________ “0 C CT o' “0 o sampling ANALYSES Ca5 LABORATORY SAMPLE PEST/ #OF PRESER­ 9L 4^ COMMENTS OO SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS CN BOTTLES VATION O (SPECIAL INSTRUCTIONS. CAUTIONS. ETC) o o c in^ 3 CD 3

I ■ I. RECEIVED BY; ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY; ANALYSES/COMMENTS. SIGM==^3—, SIGN: SIGN: PRINT; >2 . PRINT; PRINT; PRINT; FIRM; FIRM: FIRM: FIRM; DATE; TlME-./s/yy DATE: TIM^.^7 DATE: TIME: DATE: TIME:

II. RELINQUISHED BY; II. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS; SIGN: SIGN; SIGN; SIGN; PRINT: PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: DATE; TIME: DATE: TIME: DATE: TIME: DATE: TIME;

III. RELINQUISHED BY; III. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY; ANALYSES/COMMENTS. SIGN: SIGN: SIGN: SIGN: PRINT; PRINT: PRINT: PRINT: FIRM: FIRM; FIRM; FIRM: DATE; TIME; DATE; TIME: DATE; TIME: DATE: TIME:

EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON: * IF YES EXPLAIN IN REMARKS BY;